INSTRUCTIONS
TO CANDIDATES
1.
The examination application must be complete at the time
of application.
2.
If you are a member of ASEP, your check for $300 must be made payable
to
ASEP.
3.
If you are not a member of ASEP, your check of $425 (Certified
Professional Membership is $125)
must be made payable to ASEP.
4.
Please enclosed the check with the completed application.
3.
Official transcript(s) must be enclosed with the application.
PICTURE
I.D. CARD
You
must present proof of identify (e.g., driver's license or birth
certificate
with picture I.D.) to sit for the examination.
Note:
This requirement is met at the time and place of the designated exam
date
and site selection.
REVIEW
OF APPLICATIONS
After
a complete set of documents has been received, candidates will be
notified
in writing of the Boards' determination to sit for the exam. Note:
Falsified documents, fraud, or misrepresentaion of identity at the exam
will result in expulsion from ASEP and forfeiture of EPC status.
The
"Exercise
Physiologist Certified"
(EPC)
Application
SECTION
#1
Personal
Information: Print or type your full name as you wish it
to appear
on all ASEP documents and correspondence. Print or type your full
mailing address where you want your score report, admission ticket, and
all other ASEP correspondence to be sent. Note: It is your
responsibility
to notify our office of an address change by submitting in writing the
new address.
Name
Last
____________________________First __________________Initial ______
Mailing
Adress Street
___________________________City___________________State____Zip______
Social
Security Number:________-______-________
Date
of Birth: ________________________________
Day
Telephone Number: (______)________________
SECTION
#2
Membership
Information: Please indicate if you are an ASEP member.
Are
you a member of ASEP?
Yes
No (Circle one)
Note:
If you are not an ASEP member, you must include the $75 membership fee
with the submission of the EPC Certification Application.
SECTION
#3
Academic
Information: If you have already graduated at the time of
application,
complete Section #3 of the application and enclose an OFFICIAL
transcript
listing of degree and graduation date. If the official transcript
must be forwarded to us separately from the school, you MUST enclose an
unofficial transcript with your application. Note:
If
you enclose an unofficial transcript with your application, you are
required
to forward an official transcript in order to complete your file.
List
below all colleges or universities you have attended, including dates
attended
and degrees received.
Institution
Attended Dates
Attended Date
Degree
Received
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
SECTION
#4
Academic
Course Work: Enclose transcripts for all colleges and
universities
attended. Highlight the ASEP-required courses on the transcripts.
Note:
In addition to the highlighted courses on the transcript, list the
ASEP-required
course work in the spaces below. Each course must be listed on
the
transcripts.
Course
Catalog #
Course
Title
Exercise
physiology
________
_______________________________
Cardiac
rehabilitation
________
________________________________
Exercise
metabolism
________
________________________________
Kinesiology
________ ________________________________
Research
design
________ ________________________________
Sports
biomechanics
________
________________________________
Environmental
physiology
________ ________________________________
Sports
nutrition
__________
_________________________________________
Note:
Refer to the EPC Guide, Step 1- for course title comparisons.
SECTION
#5
Confidential
Property: All ASEP examination materials are the
confidential
property of ASEP and any request to review materials will be denied.
You
have read, understand, and agree to the ASEP Confidential Property
statement.
Yes
No (Circle one)
Please read
and write in your full name in the blank within the
paragraph,
at the bottom of the paragraph and, then, date the submission of the
application
I,
_____________________________, make this application for bona fide
certification
purposes only and will not disclose any information regarding the
content
of the examination, test questions, or test materials of any
kind.
I authorize ASEP to communicate the outcome of my examine score to any
and all public sector authorities, employers, and others (as it relates
specifically to the use of the title: Exercise Physiologist
Certified).
I consent to and authorize ASEP to request information relevant to this
application and my eligibility, certification, recertification, and
review
of certification and for any entity to furnish this information to
ASEP.
I hereby release, discharge, and exonerate ASEP, its officers,
directors,
employees, committee members, agents, and any person furnishing
documents,
records, and other information relating to my eligibility,
recertification,
or review of certification, from any and all liability of any nature
and
kind arising out of the furnishing or inspection of all documents,
records,
and other information and any investigation and evaluation by ASEP.
______________________________
__________
Candidate
Signature
Date
Copyright
©1997-2012
American
Society
of Exercise Physiologists
All Rights
Reserved